Dr. Jeff Hersh: What are growing pains?

Dr. Jeff Hersh

Tuesday

Aug 23, 2011 at 12:01 AMAug 23, 2011 at 10:14 PM

Q: My 8-year-old son has been having episodes of leg pain for the past few months that sometimes wake him up at night. I finally brought him to the pediatrician to have him checked out, and she said these were just growing pains and not to worry. She taught him some stretching exercises to do. Are growing pains a real medical condition?

Q: My 8-year-old son has been having episodes of leg pain for the past few months that sometimes wake him up at night. I finally brought him to the pediatrician to have him checked out, and she said these were just growing pains and not to worry. She taught him some stretching exercises to do. Are growing pains a real medical condition?

A: Growing pains are a benign self-limited condition which are not really that well understood. They are a diagnosis of exclusion, meaning that other more serious conditions must be considered and ruled out before concluding that growing pains are causing the child's symptoms.

Growing pains are very common, affecting 10 percent to 20 percent or more of children (studies on the incidence of this condition vary widely). The symptoms usually begin between the ages of 2 and 12. Growing pains are more common in kids with a family history of them.

There is no consensus on the specific definition of growing pains, but they are typically felt to be characterized by:

Leg pain (although the arms are also affected in some kids), which is most commonly bilateral and usually described as an achy/throbbing pain. The most common sites of the pain are the front of the thighs, the calves and/or behind the knees.

Pain which is usually worse at night, and will often wake the child.

Absence of joint involvement.

Episodic pain, often with many symptom-free days between episodes, which has lasted at least several months.

A normal physical examination with no swelling, rashes, fever and no limitations in range of motion. The gait is normal.

Other painful conditions (such as headaches or stomachaches) sometimes manifesting in the child as well.

Other causes of the child's symptoms (including bone tumors, infection, osteonecrosis, metabolic conditions, rheumatic conditions and others) having been ruled out, usually by a thorough history and physical examination although rarely other tests (such as X-rays or blood tests) are indicated.

Children with concerning symptoms such as worsening pain, fever, weight loss, abnormal physical examination, limping or symptoms suggestive of other conditions (such as rashes, swelling, etc.) are at increased risk of having other conditions and do not fit the diagnosis of growing pains; the required evaluation for these kids depends on the details of their symptoms/risk factors and the specific diseases the treating clinician suspects.

The exact cause of growing pains is not understood, although they are NOT felt to be related to growing (so the name is a misnomer). Specifically, studies have shown that they do not necessarily occur at the sites of rapid growth, nor are they necessarily related to periods of rapid growth.

Some experts theorize that growing pains are actually related to overuse, and this is supported by tests showing decreased speed of sound through the bones in kids with growing pains (a finding also seen in overuse syndromes). However, other etiologies, including increased pain sensitivity, restless leg syndrome, psychosocial factors and other conditions, have been theorized as possible etiologies as well.

Growing pains are treated symptomatically with heating pads (or other sources of gentle heat), massage and/or over-the-counter analgesics such as ibuprofen or acetaminophen (aspirin should be avoided in young children due to a rare complication called Reye syndrome). The fact that massage helps alleviate the symptoms of growing pains actually differentiates it from many other causes of leg pain, and is considered by many physicians to be a finding that supports the diagnosis.

If you think your child may be having growing pains you should be sure they are evaluated by their health care provider so other conditions can be ruled out. Growing pains usually resolve within a couple of years.

Some studies have shown that muscle stretching exercises are beneficial to many children with this condition, significantly hastening the resolution of symptoms, so they are often prescribed by the treating clinician.